| NPI | 1528498318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MEDLEY MATTINGLY Fpp Supervisor 502-321-7618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: KY 1041C0700X) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |